Female Genitalia Flashcards
(122 cards)
1
Q
what are risk factors of pelvic floor weakness
A
- aging
- Prior surgery or trauma
- childbirth
- obesity, DM, MS, parkinsons
- meds
- chronically increased abdominal exam
2
Q
what are the fornix’
A
the corners of the cervix
3
Q
what can weakness of the pelvic floor muscles cause?
A
- pain
- urinary or fecal incontinence
- Prolapse of the pelvic organs
4
Q
what are important questions to ask in history?
A
- contraception type
- cervical cytology
- history of gynecological findings
- history of gynecological/abdominal procedures
- screening for intimate partner violence
5
Q
what is the average age of menarche
A
9-16 yo in the US
6
Q
LMP
A
last menstual period
7
Q
PMP
A
prior menstrual period
8
Q
How to calculate cycle
A
first day of period to first day of period
9
Q
what is pain with menses
A
Dysmenorrhea
10
Q
what f/u questions should be asked if experiencing dysmenorrhea
A
- pain
- length
- does it impact ADL
- associated symptoms
11
Q
what causes primary dysmenorrhea
A
- no specific organic cause
12
Q
what hormone increase can attribute to Primary dysmenorrhea
A
increased prostoglandin production
13
Q
what causes secondary dysmenorrhea
A
ORGANIC cause
* endometriosis
* adenmyosis
* PID
* Endometrial polyps
14
Q
what is emotional and behavioral symptoms such as sleep disturbances, poor concentration, social withdrawl etc in menstruating women?
in regards to period
A
Premenstrual syndrome (PMS)
15
Q
what are the 3 criterias for diagnosis of PMS
A
- occur in the 5 days before menses for 3 cycles
- resolves within 4 days after menses onsest
- interferes with daily activities
16
Q
what is amenorrhea
A
absense of periods
17
Q
what is polymenorrhea
A
less than 21 days between menses
18
Q
oligomenorrhea
A
infrequent bleeding
19
Q
menorrhagia
A
excessive flow
20
Q
metrorrhagia
A
intermenstrual bleeding
21
Q
postcoital bleeding
A
post sex bleeding
22
Q
PALM COEIN
A
structural: Polyp, Adenomyosis, Leiomyoma, Malignancy
Non-Structural: Coagulopathy, Ovulatory, Endometrial, Iatrogenic, Not classified
causes of abornmal bleeding
23
Q
cessation of menses for ___ months is
A
menopause
24
Q
what age does menopause occur
A
between 48-55
25
hot flashes, flushing sweating, are what type of symptoms of menopause
vasomotor symptoms
26
what is erratic cyclical bleeding and vasomotor symptoms before menses cease
perimenopause
27
what is bleeding post menopause concerning for
early sign of cancer
28
full term delivery is after what week
37 weeks
29
preterm labor is between what weeks
20-36 weeks and 6 days
30
what is an abortion classified as
loss of pregnancy before 20 weeks
31
what color is healthy discharge
white
32
what can pink vaginal discharge be from
* cervical bleeding
* vaginal irritation
* implantation
*
33
what can cause gray vaginal discharge
bacterial vaginosis or trichomoniasis
34
what causes yellow/green discharge
sexually transmitted infection (gonorrhea, chlamydia, trichomoniasis)
35
what caues red vaginal discharge
* menstruation
* cervical infection
* cervical polp
* endometrial or cervical cancer
36
what is the most common type of acute pain?
Pelvic inflammatory disease
37
History of STIs and recent IUD insertion are red flags for what?
PID
38
what are the three most common causes of acute pelvic pain
* PID
* ruptured ovarian cyst
* appendicitis
39
what is a mild, one sided pelvic pain that lasts longer than a few hours midcycle (from ovulation)
Mittelshmerz
40
what differential diagnoses should always be included for acute pelvic pain
* ectopic pregnancy
* ovarian torsion
* appendicitis
41
what should ALWAYS be ruled out in pts of reproductive age with abdominal pain?
ectopic pregnancy; use HcG levels or TVUS
42
what is pelvic pain that lasts longer than 6 months and doesn't respond to treatment
Chronic pelvic pain
43
what are the DDx of chronic pelvic pain>
* endometriosis
* adenomyosis
* myomas (fibroids)
44
what are some cervical cancer risk factors?
* HPV infection
* failure to screen
* smoking
* multiple partners
* immunosuppression
* long term contraception use
* chlamydia trachomatis coinfection
* parity
* prior cervical cancer
45
when do you start screening and what is the interval
21 years
cyctology q3 years or
21-29yo: cytology q3 years and 30-64 yo: cytology + HPV q5 years
46
when do you stop screening for cervical cancer
age 65 + 3 consecutive negative cytology
47
pap smear stands for
papanicolaou test
48
what is a procecure where a brush is used to remove cells from the cervix to be check for atypia
pap smear
49
what is a procedure that takes a samples of cervical cells to check for HPV 16 and 18
hrHPV
50
what is the 5th leading cause of cancer death in women?
ovarian cancer
51
what cancer has no effective screen tests
ovarian cancer
52
what can CA-125 indicated
it can be elevated in women with ovarian cancer but also breast cancer (prostate ect)
53
what 3 symptoms indicate concern for ovarian cancer in women >50
* abdominal distention
* abdominal bloating
* urinary frequency
54
what are the risk factors of ovarian cancer
* family history of breast or ovarian
* BRCA1 or BRCA 2
* obesity
* nulliparity
* post menopausal hormone replacement therapy
55
what is the most common reported STI in the us right now
chlamydia trachomatis
56
what is the mc way to test for STI
dirty urine sample (doesn't test for gonorrhea)
57
what population should have screening of chlamydia, syphilis, hep b, and HIV
pregnant women (add gonorrhea for at risk women)
58
# for chlamydia, gonorrhea,
when should you test for STIs in women
sexually active <25 yo and retest 3 months post treatment
59
when should you screen for syphilis
asymptomatic adults at increased risk (incarceration or transactional work)
60
when should you screen for trichomonas
women receiving care in high prevelance setting (STI clinics, correctional facility)
61
what are the screening recs for HIV?
all women 13-64 at least 1x
62
what are the recommendations for screening for HPV and cervical cancer?
women 21-29yo q3 years
women 3-65 yo q3 years or q5 year combo with cytology and HPV testing
63
what are the screening recommendations for HepB
women at increased risk (more than 2 partners in 6 months)
64
what are the screening guildelines for Hep C
all adults over 18 yo
65
what are the two most common hernias in females
1. indirect
2. direct
3. femoral
66
what is tanner stage 1
prepubertal, no pubic hair
67
tanner stage 2
sparse hair growth with minimally pigmented hair, mainly on the labia
68
what is tanner stage 3
considerably darker and coarser hair spreading over the mons pubis
69
what is tanner stage 4
thick adult-type hair that does not spread to the medial surface of the thighs
70
what is tanner stage 5
adult type hair that is distributed on classical inverse triangle
71
what is the lithotomy position
* heels in footrest
* but exrtending slightly beyond the table
* thighs flexed, abducted, externally rotated at the hips
* head supported by a pillow
* hands on the side or folded on her chest
72
2 shapes of a speculum
1. graves (wider-vaginal prolapse)
2. Pedersen (for everything else)
73
what angle should the speculum be at?
30-45 degree
74
what should flagellated, motile trichomonads
Trichomonas on a wet prep
75
what shows clue cells?
bacterial vaginosis
76
what is the name of the vaginal pH testing paper
litmus paper
77
what is the normal vaginal pH
<4.5
78
what does a pH greater than 4.5 indicated?
bacterial vaginosis, trichomonas
79
what method of herpes culture sample is more likely to be a false positive
swabbing the residual erosions
80
chandelier sign is a hallmark of
PID (cervical motion tenderness)
81
what may cause the uterus to not be palpable
retroversion or retroflexion of the uterus
82
what is the average size of a ovary
3.5cm x 2cm x 1.5cm
83
when are ovaries not palpable
within 3-5 years of menopause onset
84
what can cause adnexal masses?
1. tubo ovarian abscess
2. salpingitis
3. ectopic pregnancy
4. PID
5. malignancy
85
what are the indicates for rectovaginal examination
1. to palpate a retroverted uterus, uterosacral ligament, cul-de-sac
2. colorectal cancer >45
3. pelvic pathology
86
what is a small, firm, round, cystic nodule in the labia
epidermoid cyst (benign)
87
what color discharge is associated with epidermoid cyst
white or yellowish
88
what is cauliflower-shaped or verrucous lesions
condyloma acuminatum
89
what is hyperpigmented, smooth, broad based, flat topped papules?
condyloma latum
| a manifestation of secondary syphilis
90
what is a firm **PAINLESS** ulcer
syphilitic chancre from treponema pallidum
91
what is localized vesicles followed by **PAINFUL** ulcer on an erythematous base?
genital herpes
92
what is the most common cause of genital herpes
HSV-1 and HSV-2
93
what is an ulcerated or raise red vulvar lesion
carcinoma of the vulva
94
what is the most common type of carcinoma of the vulva
squamous cell carcinoma
95
what is a bulge of the upper 2/3 of the anterior vaginal wall? what causes it?
cystocele
caused by: bladder prolapse/shifting
96
what is a bulge of the entire anterior vaginal wall? waht causes it?
cystourethrocele
bladder and urethra
97
what is a herniation of the rectum into the posterior wall of the vagina?
rectocele
98
what is a small, red, benign tumor at posterior urethral meatus?
urethral caruncle
| mostly in post menopausal women & aysmptomatic
99
what is a tense, hot, tender gland that has purulent drainage from the ducts?
acute bartholin gland infection
100
what is a red swollen RING around the urethral meatus
prolapse of the urethral mucosa
| pre-menarche or post menopausal
101
what is a nontender, cystic nodule at the edge of the labia
chronic bartholin gland infection
102
what is the characteristics of trichomonal vaginitis?
1. yellow/green/gray and malodorus discharge
2. straberry cervix
3. wet mount prep
4. pH >4.5
103
what are characteristics of candidal Vaginitis
* white, curdy, thick discsharge
* reddened vaginal mucosa with white patches of discharge
* branching hyphae on KOH prep
* pH <4.5
104
what are characteristics of bacterial vaginosis
1. gray or white, thin discharge
2. malodorous discharge (fishy)
3. normal appearance on exam
4. saline wet mount for clue cells
5. positive whiff test
6. pH >4.5
105
what is a nulliparous os look like
oval
106
what does a parous os look like
slit-like
107
what is a nabothian cyst
"retention cyst"
* translucent nodules with no pathologic significance
108
what are charcteristics of cervical polyps
benign but may bleed
arises from the endocervical canal
109
characterstics of mucopurulent cervicitis
* purulent yellow discharge
* from c. trachomatis, n. gonorrhoeae, herpes infections
110
what can later stages of carcinoma of the cervix look like?
irregular cauliflower-like growth that may develop
111
what are characteristics of fetal exposure of DES
* columnar epithelium covere most or all of the cervix
* there is a circular collar or ridge of tissue between the cervix and vagina
112
what is the tilting backwards of the entire uterus so the cervix faces forward
retroversion of the uterus
* uterine body can not be felt with abdominal hand
113
what is the backward angulation of the body of the uterus in relation to the cervix, and the cervix remains in its usual position>
retroflexion of the uterus and the uterine body can not be felt with abdominal hand
114
what is first degree uterine prolapse
cervix falls into the upper part of the vagina
115
what is 2nd degree uterine prolapse
cervix is at the vaginal introitus
116
what is 3rd degree uterine prolapse
cervix and part of the uterus is outside of the vaginal introitus
117
what is 4th degree uterine prolapse (procidentia)
the cervix and all of the uterus falls out of vagina
118
what type of mass on the ovary is benign, smooth, and compressible
ovarian cyst
119
what is a mass that is firm, and more nodular on the ovary?
ovarian cancer
experience symptoms of pelvic pain, bloating, abdominal size and uti symptoms
120
what has a palpable adenexal mass in more the 1/2 of cases
ectopic pregnancy
121
what are clinical features of ectopic pregnancy
* abdominal pain
* adnexal tenderness
* abnormal uterine bleeding
122
what may PID develop into
tubo-ovarian abscess
